In the summer of 2015, the East Main Street branch of Optimus Health Care planned, developed, and initiated a quality improvement interven-tion for pediatric asthma care. The intervention consisted of a provider-designed EMR template to enhance asthma clinic visits, a new on-site spi-rometer, and new tools for patient and staff education. The objective was to support Optimus providers in their efforts to provide high quality, guideline-compliant care to their patients and thereby improve patient outcomes. A chart audit of 27 patient records conducted six months after the beginning of the project found high rates of compliance with two im-portant measures of quality asthma care: spirometer use (85% of charts) and documentation of an asthma action plan (96% of charts.)

National surveys conducted on community-dwelling older adults have reported the overall prevalence of elder abuse to be approximately 10% in the US.1 For every elder abuse case known to programs and agencies, an estimated 24 cases go unreported.2 Since the criminalization of elder abuse in the 1990's, law enforcement officers (LEOs) are in a unique position to detect and respond to elder abuse cases. Despite increased interaction between LEOs and elderly persons in the community, LEOs report significant knowledge gaps in responding to elder abuse cases.3,4 Currently, there are no known instruments used by LEOs to assess for risk of elder abuse. The Elder Abuse Suspicion Index (EASI),5 a screening tool previously validated for use by physicians in clinical settings, shows potential for use by officers. This report presents findings from a survey and interviews with LEOs and community advocates in the state of Connecticut exploring acceptability of the EASI as a law enforcement screening tool.

Bridgeport Hospital, Greenwich Hospital, and Yale-New Haven Hospital are nonprofit hospitals that are part of the Yale New Haven Health System (YNHHS). Table 1 outlines the towns covered by each hospital’s service delivery network.

In order for nonprofit hospitals to remain tax-exempt, they must comply with federal requirements to provide “community benefits,” as outlined in Section 9007 of the Affordable Care Act (ACA). One provision outlined in the ACA requires nonprofit hospitals to “give increased attention to working with others to determine community health needs and take action to meet those needs”. This requirement is fulfilled in part by the triennial completion of a Community Health Needs Assessment (CHNA) with community partners.

This report presents findings from the first stage of the second round of the community health improvement coalitions, which include all three YNHHS hospitals, CHNA: the key informant interviews. These interviews incorporate input from persons representing the broad community served by the hospitals, focusing on a range of public health issues relevant to the community at large. Input was gathered through an online survey of key informant perceptions surrounding community health.

Key informants comprised two groups: (1) Health and Human Service representatives and (2) Government and Community Leader representatives. This report outlines the top health issues and barriers to good health in the communities served as identified and prioritized by key informants, as well as suggestions they have to address these concerns.

To characterize the perceptions, attitudes, and behaviors surrounding active transportation among key stakeholders in Norwalk. Specifically, the project aimed to identify: 1. Social, physical, and financial barriers to walking and biking 2. Perceived importance and utility of bike lanes and sidewalks 3. Priority improvements to make the city more conducive to active transportation 4. The most important areas on which to educate the general public about active transportation

Optimus, a Joint Commission accredited and a federally qualified healthcare center (FQHC), serves over 1200 pregnant women a year. Excessive Gestational Weight Gain (GWG) can lead to maternal health complications, including gestational diabetes, preeclampsia and increased risk for C-section. This study seeks to assess the prevalence and magnitude of GWG among Optimus clients, evaluate nutrition services available for pregnant women at Optimus, and identify approaches to enhancing pregnancy outcomes through optimum GWG that can be made available to Optimus clients.

Methods

Data on weight gain patterns, socio- demographic information, and health history for all pregnant women with clinic visits between 01/01/2013 and 12/31/2013 were extracted from the Optimus’ electronic medical records system. Trends in weight gain during each trimester were compared and analyzed by age, education, race/ethnicity, country of origin and language. Gaps in available nutrition services for pregnant women were determined through staff interviews and surveys.

Results

Overall, the weight trends of the clients who used Optimus’ prenatal services in 2013 increased across the trimesters. There were no significant differences in weight gain between trimesters by all variables evaluated (age, education, race/ethnicity, country of origin and language). Teenage mothers had the lowest weights during each trimester of pregnancy while mothers with advanced maternal age had the highest average weights per trimester. On average, Black women had the highest weight from the first trimester and continued to do so throughout pregnancy. Women with only elementary or middle school education gained on average of 9.19lbs over the course of the three trimesters. This value is lower than the minimum that is recommended by the Institute of Medicine for any women in spite of their 3 BMI (11lbs). Results from the survey showed that Optimus’ staff consider cost, time and emotional barriers to be potential barriers to caring for pregnant women at Optimus.

Conclusions

Special educational nutrition services should be offered to women who represent the highest risk groups at Optimus (teenage mothers, mothers of advance maternal age, mothers with only middle school education or lower and also African American women). Optimus’ staff should account for cost, time and emotional barriers when designing nutritional and other support services for Optimus’ clients.

Medicaid family planning expansion programs have been shown to improve reproductive health outcomes and reduce unintended pregnancies. Connecticut implemented Medicaid Family Planning Expansion in March of 2012 with the intention of expanding access to family planning services and improving reproductive health outcomes. The aims of this study are to evaluate the effectiveness of the Medicaid Family Planning Expansion in reducing unintended pregnancies, estimate the funds saved to the state of Connecticut due to the expansion and to demonstrate that women will choose highly effective methods of contraception when cost is not a barrier.

Methods

Mathematical models developed by the Guttmacher Institute were adapted to estimate the number of pregnancies averted in the state based on patterns of contraceptive use in participants after enrolling in the program and contraceptive failure rates. The number of pregnancies averted was used to determine the state funds saved by reducing pregnancies that would have resulted in births covered by Medicaid. Multivariate logistic regression was used to examine predictors of using a highly effective method of contraception.

Results

Complete data were available for 1,153 women enrolled in the Medicaid Family Planning Expansion program. Our calculations indicated that an estimated 84 unintended pregnancies were averted in this group between 2011 and 2013, with an estimated 31.2 unintended births averted and $324,379 saved to the state of Connecticut. Women enrolled in the expansion program were more likely to choose a highly effective method of contraception than women not enrolled (OR: 7.16, 95% CI: 5.76, 8.90).

Discussion

Our results support the conclusion that when the barrier of cost is removed, women are more likely to choose highly effective methods of contraception, helping them to avoid unintended pregnancies. Our results suggest the need for continued funding of Medicaid Family Planning Expansion in Connecticut, and further research on barriers to enrollment in the program.

The Haven clinic is a volunteer and student-run clinic serving low-income residents of the Fair Haven community in New Haven, CT. The Advancing Nutrition and Dietary Outcomes (ANDO) program is a one-on-one counseling program for patients at risk for chronic disease. This project aimed to evaluate the ANDO program for efficacy and patient satisfaction.

Methods

Two main data collection methods were used to assess the efficacy and patient satisfaction with ANDO, resulting in a mixed methods analysis. A baseline survey instrument measured patient skills, knowledge and attitudes about healthy eating and physical activity. Key informant interviews gauged these same topics as well as satisfaction with the program.

Results

Survey results revealed a strongly positive attitude towards improving diet and increasing physical activity as ways of overcoming chronic disease. Surveys also illustrated the lack of knowledge and skills of patients to make those lifestyle changes on their own. Interviews with patients who have gone through at least one module of ANDO revealed strong satisfaction with the program, though some suggestions for improvement were made.

Conclusions

The ANDO program is a strong patient-focused program that reaches a portion of the target population in the Fair Haven community. Patients who enroll are satisfied with the program and offer suggestions for continued strength of the program including group sessions and consistent counselors. Evaluation team recommendations include producing a thorough program manual for more program consistency, administering pre- and post-program surveys with future patients, and conducting an evaluability assessment prior to future evaluation endeavors.

The role of community health workers (CHWs) is a growing profession throughout the United States. These individuals have been a valuable supplement to healthcare systems because their work has reduced disparities in health access and contain costs, especially in hard-to-reach areas and underserved populations. However, issues of legitimacy, centralization, and sustainability challenge the effectiveness of such programs. In Connecticut especially, the CHW program lacks clarity and perhaps most importantly a sustainable means of financially supporting CHWs. This lack of steady funding leads to high attrition rates and missed opportunities for full-time employment of passionate individuals who can make a positive difference in communities where they live. Investigation into the potential payment methods for CHWs is critical if Connecticut is to have a long-term sustainable community-based program. Through a partnership with Southwestern Area Health Education Center (SW AHEC), Inc., our team of graduate and professional students from the Yale School of Public Health collected data from public and private payers regarding identification of sustainable payment methods for CHWs in the state. Interviews were conducted with key informants from various entities including Medicaid, State Innovation Model Connecticut (SIM-CT), private state payers, and private national payers. Our team hypothesized that payers would express interest in incorporating CHWs into their payment plans and would provide information regarding action steps toward making this change. The project deliverable was an analysis based on data collected from secondary sources and feedback from payer interviewees regarding how CHWs can become fully involved into delivering healthcare to underserved populations within healthcare reform programs. This analysis took into consideration new programs being recommended by the Patient Protection and Affordable Care Act (PPACA) and SIM-CT that will be presented to healthcare stakeholders, including SW AHEC, in order to advance the legitimacy and sustainability of the CHW program in Connecticut. Our findings show that several payers are interested in providing sustainable funding for CHWs through their plans but there still exist several barriers to make this advancement a reality. Future investigation is necessary to determine specific steps that ought to be taken to include CHWs in healthcare teams under the guidelines of PPACA. In addition, feedback from providers, who work directly with CHWs and other auxiliary health promoters should be gathered and analyzed.

Homelessness is a widespread problem, particularly of urban environments, and has been growing over the last two decades nationally. It is estimated that between 2.5 to 3.5 million people, including 1.35 million children, are homeless in the United States in a given year and the likelihood of becoming homeless is 7.5% over an individual's lifetime. Much of the homeless population reports physical health, mental health, alcohol and substance abuse, and social problems. New London Homeless Hospitality Center (NLHHC) has recently opened a respite care facility to help coordinate care and provide basic medical attention. This report will examine the premise and progress of this effort.

Methods

A literature review was developed to provide the national and local facts and trends on homelessness and respite care. Several key informant interviews were conducted to provide qualitative data on program specific respite services in the New London community. Additionally, a model for cost-effectiveness was proposed, based upon the unit-costing approach for health care.

Results

The median length of stay at the respite was found to be 10 days. The unit-costing is based on inputs from the interviews and existing respite records. When data were missing, assumptions were made to estimate the unit costs for each distinct output recognized. Such assumptions are disclosed herein. Semi-structured key informant interviews with guests revealed that the respite program is their only and last opportunity for shelter and recuperation in times of injury and illness. Moreover, we found that the respite feature of NLHHC's services is in general satisfactory to them in fulfilling their human service needs, although the shelter's facilitation of interaction between guests and social service agencies could be improved to assure the continuum of care following respite stay. Interviews with Lawrence and Memorial (L&M) Hospital and NLHHC staff demonstrated accord that the respite program is effective and serves a vital need in the community, although communication and coordination between NLHHC and L&M could be improved, especially apropos of enhancing homelessness detection (and thus respite guest referral) via the hospital's intake process.

Conclusions

The NLHHC respite center is new, but has already demonstrated positive impact. Respite guests and staff give anecdotal evidence that this is a needed community resource. The humanitarian and social benefit is substantial. Quantitative evaluation has not yet been applied, but in other locales respite care has been successful at reducing costs. We recommend continued research and monitoring of this innovative program for fiscal effectiveness and excellence in guest services.